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Thrombolytic Therapy of Axillary-Subclavian Venous Thrombosis

Thrombolytic Therapy of Axillary-Subclavian Venous Thrombosis Abstract To the Editor.—The article by Landercasper et al1 may lead readers to the wrong conclusion that thrombosis of the axillary-subclavian vein can be treated successfully with systemic thrombolytic therapy, as used in the four cases described in the article. Although thrombolytic therapy has already been tried in this syndrome by several investigators, including me, the success of the treatment is limited to dissolution of the clots. However, the basic problem of extrinsic constriction of the vein and intimal tear is not solved by this therapy alone. The simultaneous use of anticoagulation and surgery has been proposed by several groups; however, Landercasper et al used these methods in sequence in two of their patients. Even the posttreatment venogram in the article shows a definite constriction of the vein at the level of the inner third of the clavicle. This has been the problem in all of these cases, and References 1. Landercasper J, Gall W, Fischer M, et al: Thrombolytic therapy of axillary-subclavian venous thrombosis . Arch Surg 1987;122:1072-1075.Crossref 2. Hughes JP, Ochsner JL, Sartor DW: Surgical treatment of primary thrombosis of the subclavian-axillary vein . J La Med Soc 1974;126:77-79. 3. Campbell CB, Chandler JG, Tegtmeyer CJ, et al: Axillary, subclavian, and brachiocephalic vein obstruction . Surgery 1977;82:816-826. 4. McCleery RS, Kesterson JE, Kirtley JA, et al: Subclavius and anterior scalene muscle compression as a cause of intermittent obstruction of the subclavian vein . Ann Surg 1951;133:588-602.Crossref 5. Adams JT, DeWeese JA: 'Effort'thrombosis of the axillary and subclavian veins . J Trauma 1971;11:923-930.Crossref 6. Swinton NW, Edgett JW, Hall RJ: Primary subclavian-axillary vein thrombosis . Circulation 1968;38:737-745.Crossref 7. Kleinsasser LJ: 'Effort' thrombosis of the axillary and subclavian veins . Arch Surg 1949;59:258-274.Crossref 8. Hughes ESR: Venous obstruction in the upper extremity (Paget-Schroetter's syndrome) . Surg Gynecol Obstet 1949;88:89-127. 9. Drapanas T, Curran WL: Thrombectomy in the treatment of'effort' thrombosis of the axillary and subclavian veins . J Trauma 1966;6:107-119.Crossref 10. Molina JE: The syndrome of venous thoracic outlet obstruction: Treatment and results . Proceedings of 14th World Congress International Union of Angiology , Munich, (July 6) -11, 1986, p 106. 11. Aziz S, Straehley CJ, Whelan TJ: Effort-related axillosubclavian vein thrombosis: A new theory of pathogenesis and a plea for direct surgical intervention . Am J Surg 1986;152:57-61.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Thrombolytic Therapy of Axillary-Subclavian Venous Thrombosis

Archives of Surgery , Volume 123 (5) – May 1, 1988

Thrombolytic Therapy of Axillary-Subclavian Venous Thrombosis

Abstract

Abstract To the Editor.—The article by Landercasper et al1 may lead readers to the wrong conclusion that thrombosis of the axillary-subclavian vein can be treated successfully with systemic thrombolytic therapy, as used in the four cases described in the article. Although thrombolytic therapy has already been tried in this syndrome by several investigators, including me, the success of the treatment is limited to dissolution of the clots. However, the basic problem of extrinsic...
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Publisher
American Medical Association
Copyright
Copyright © 1988 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1988.01400290148028
Publisher site
See Article on Publisher Site

Abstract

Abstract To the Editor.—The article by Landercasper et al1 may lead readers to the wrong conclusion that thrombosis of the axillary-subclavian vein can be treated successfully with systemic thrombolytic therapy, as used in the four cases described in the article. Although thrombolytic therapy has already been tried in this syndrome by several investigators, including me, the success of the treatment is limited to dissolution of the clots. However, the basic problem of extrinsic constriction of the vein and intimal tear is not solved by this therapy alone. The simultaneous use of anticoagulation and surgery has been proposed by several groups; however, Landercasper et al used these methods in sequence in two of their patients. Even the posttreatment venogram in the article shows a definite constriction of the vein at the level of the inner third of the clavicle. This has been the problem in all of these cases, and References 1. Landercasper J, Gall W, Fischer M, et al: Thrombolytic therapy of axillary-subclavian venous thrombosis . Arch Surg 1987;122:1072-1075.Crossref 2. Hughes JP, Ochsner JL, Sartor DW: Surgical treatment of primary thrombosis of the subclavian-axillary vein . J La Med Soc 1974;126:77-79. 3. Campbell CB, Chandler JG, Tegtmeyer CJ, et al: Axillary, subclavian, and brachiocephalic vein obstruction . Surgery 1977;82:816-826. 4. McCleery RS, Kesterson JE, Kirtley JA, et al: Subclavius and anterior scalene muscle compression as a cause of intermittent obstruction of the subclavian vein . Ann Surg 1951;133:588-602.Crossref 5. Adams JT, DeWeese JA: 'Effort'thrombosis of the axillary and subclavian veins . J Trauma 1971;11:923-930.Crossref 6. Swinton NW, Edgett JW, Hall RJ: Primary subclavian-axillary vein thrombosis . Circulation 1968;38:737-745.Crossref 7. Kleinsasser LJ: 'Effort' thrombosis of the axillary and subclavian veins . Arch Surg 1949;59:258-274.Crossref 8. Hughes ESR: Venous obstruction in the upper extremity (Paget-Schroetter's syndrome) . Surg Gynecol Obstet 1949;88:89-127. 9. Drapanas T, Curran WL: Thrombectomy in the treatment of'effort' thrombosis of the axillary and subclavian veins . J Trauma 1966;6:107-119.Crossref 10. Molina JE: The syndrome of venous thoracic outlet obstruction: Treatment and results . Proceedings of 14th World Congress International Union of Angiology , Munich, (July 6) -11, 1986, p 106. 11. Aziz S, Straehley CJ, Whelan TJ: Effort-related axillosubclavian vein thrombosis: A new theory of pathogenesis and a plea for direct surgical intervention . Am J Surg 1986;152:57-61.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: May 1, 1988

References